Digestion
Digestive Questionnaire
Digestive weakness may be related to many other secondary health concerns. Up to 70% of immunity is related to digestive function which in turn is related to the adrenal gland. Proper assessment and a treatment plan are important to optimize one’s health.
This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to your degree of overall digestive risk. It is not a substitute for professional medical advice from your health care provider.
For each “Yes” answer, put a Y in the space and total the number at the end
1.____ Are you susceptible to viruses and/or infections?
2 .____ Do you frequently have bloating, gas, burping?
3. ____ Do you eat at your desk, in your car, on the run or while doing other things?
4. ____ Do you lack sleep or feel tired or “ wired”?
5. ____ Do you have ridges, spots or weak fingernails?
6. ____ Do you have a coating on the middle portion of your tongue?
7. ____ Do you feel unwell after certain foods?
8. ____ Do you experience alternating bowl movements?
9. ____ Do you feel nausea or vomit often?
10. ____ Do you have frequent skin rashes or eruptions?
11. ____ Do you experience fatigue not helped by rest?
12. ____ Do you feel you should be eating a healthier diet?
13. ____ Do you have a family history of having digestive concerns? Ie celiac, irritable bowl syndrome, malabsorption, cancer of the bowl, colitis, chron’s
If you have 2 or more Y answers you may be at risk for digestive conditions.
It is recommended to consult with your health care professional team.
